1. Field of the Invention
This invention relates to surgical instrumentation and more particularly to an instrument and method for retracting or repositioning a distal anatomic structure having a lumen to facilitate an endoscopic surgery.
2. Description of the Prior Art
In a "minimally invasive" endoscopic surgery, for example in an insufflated abdominal cavity, dissection, cutting and suturing are performed with various elongate instruments introduced into the interior of the body through cannulas. It has been found that some endoscopic procedures are complex and time-consuming because of difficulties in retracting or repositioning organs or structures with an elongate instrument (e.g., a grasper). Since all such instruments are introduced through cannulas (tubes) which are in stationary positions, it often is difficult to lift, rotate, reposition or otherwise retract an anatomic structure to access the site of the actual procedure. On occasion, the retracting instruments have to cross the region of dissection, obstructing the surgeon's view and interfering with the dissecting instruments.
An illustrative example of a procedure that is difficult to perform endoscopically is a gastric wrap (e.g., a "Nissen fundoplication") for alleviating gastroesophageal reflux. In such a fundoplication, the surgeon develops a fold or plication in the fundus of the stomach and then wraps and sutures the plication generally around the gastroesophageal junction. To accomplish the procedure endoscopically, the surgeon must mobilize the esophagus and fundus by dissecting connective tissues behind the structures, then grasp the exterior of the fundus and drag it behind and around the esophagus, then suture the plication in place. Such retraction procedures are difficult to accomplish with conventional endoscopic graspers. An open surgery to accomplish a fundoplication is undesirable because it requires lengthy postoperative recuperation and also requires a long disfiguring upper abdominal incision. There is therefore a need for new instruments and methods for retracting or repositioning anatomic structures in a "minimally invasive" surgery and particularly for accomplishing the retraction of the esophagus and fundus in an endoscopic anti-reflux procedure.